23799 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALJ, POINT PEN ONLY
Building P,.JLt Identification PERMIT NO,
BuOding Adding: c�t2t�.E �sr'8 23799
I'he:
A+ DIAALZ– uta 733 -9b`Y CITY OF CUPERTINO-BUILDING DIVISION / J
mt.rxm•.Name: t�Lk.
N.
APPLICATION I PERMIT ' IO r1
BUTI.DINGHI. I'LUMBINGMECIIAMGV, CATTi'ARY CONIROLa
A Ites/Englneer. @Na
dQTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO "
O
A ' O PFRMIT'ISSUANCE
IIS L ENSEDCONTRACTOR'S DECLARATION -
Ikrtbyatfirm<hatlam lkensed underprovWon of a,pter9(comm., APPLIANCI RESIDENTIAL
JOB D6CRIPITON
Ingwlth5ectbn7000)of DIVW°n 3o/NeBuelnes.and PsufesatmeCode,and my
d'Oft PN
Likens Clans L ` 3 "uj
ntntior UP 1`02DOAM�S \/V•
.
ARCHITE 10 AMPS
I unlenUrd my plans akB be used so public records. OVER IODO AMPS SQ.FT.FLOOR AREA,' S/SQ.FT.
Licensed Professional SIGNSELEC7RICAL 1-7 SO \�—YIlaY7
' OWNER-ENLDER DECLARATION 1-7
zf, �c; Ihembyaffirmtktlenexempt fromthe Contranor'sLbeve Lawfortk aA�a^���.
po pq following resson.6eNm70715,Businesand Pmfcabtu Code:Mycity°r ��/
i�ZI"'ry countywhkhrequlresapen mtnrot MOter,lm e,demoih r TFMP.MEITEOft NSI.
,fie'`� ^7J anyaWeiurt prionentthercgaLwrtqupntheap�thB ret on,u, perml�to InV✓FJID - - '
file,signed statement that lu h 9(corn pursuant it she ti..70om of the
� Contractors Lkrreelaw(Ckpter9(comrrcnMg with Relies.7000)or Divi-
'0 SWISUGN LFLECTRIC
��OS aon3ofthe BuslnnendlidubnCode)orthat heheremptthertfromeM VALUATION
Sr' tk bash for the alleged exemption. Any violation of Section 70715 by any CC
�ed appBtantf°rape tsubjec e.pphanttossdlpe.Hydnamo.than SWI(CHINTiFDCIl/R6 1 ��� K
�u
in, hundred dela.(5500)
l .
` f,n .ownof the property,or my employees with wag.as their sole RESIDENTIAL ELECTR _ SIORIES TYPE CONSTRUCTION
I H �66 mmpeos Klon,wal d o I weak,and the nsusum is cot lot.ded or Ofrerea for '
.GG O a le6ec7DKBua1rcu.M Pmlesbn,Cade:ik Cont.sol.LImnse law
(jSg does not appy to an'owner of pmperty who builds or improves thereon,and OCC.GROUP RES.UNITS
-
&& whodoessuch wort himselfurthtough hbown employees,provided that such
I� Impmvemenbamnmintendedorofferedfmmle.Ilhowever,tkbufidingm
Imp mcNba°IdwN omyurofcomplel mtkavner-buOderwil ve
I tR�L*rdenofprodrythakdldMWUdorbnprovefmpugp ofuk.). QTY. PLUMBING PERMIT FEE
LJ L n owner of the property,.m e.luah ely contracting with liomaed FLOODZONE APN
` mntnctms to mrutruct the pro)en(See 7044,Buinesatd Prdesbm Code: PERMIT ISSUANCE
I� TTe Com.aor'a Lice.Law does not appy to n owner of property who i
�. builds or Improv theeem and who commas for such p(ojetls with a ALTER-DRAIN&VENT'-WATER(EA)
cgRlfutoRe)Ilmued puna..to the Cmdnctra.License law. BACK PLOW PROTECT.DEVICE
SUMMARY
IJ I am xempt under Sec B Q P C for this reason
Owner Dau S R. OF,AREA,ODND.
MENR
DRAINFLOOR.ROOF, SANITARY Y N
KE=Pr
( WORKAN COMPENSATION DECLARATION FDCIURESPER TRAP SCI300LTAX Y N_
Ill ❑I hereby aHlrm that 1 low nni0consentute of consent to ae0-Uwa., a RmElvr
mrtI(IoteofWorkan'Compewtl°nlmun manrtffkdmpytheneof(Scc.
3800,lab CJ GAS EA.SYSTEM-t INGt OUTLETS PARK FEE Y N
I PolicyI R EllplI
y GAPIEA.fgrqKfiVR 4(FA) BUILDING DIVISION FEES
Il
Certified copy h hertby(umWed. / D Asn INTERCpxmR PLAN F 'EE
m CertNed copy h(fled with lk city Iropectbn divb(on. 6 �• —�
I CERTIFICATE OF EXEMPTION FROM WORKERS GREASE TRAP PAID
COMPENSATION INSURANCE SEWER-SANITARY SIDRM EA 20�I Date Reoei t#
Chic lesson need ns kcmnpleted Htk permit h(more hundred dolls.
8100 "yt') WAITx F-IFATFRW/VENT/E3.ECTR ENERGYFEE Y N
Imncttr itbthep,nizintrety n.c,sorwMNWap,sub)e t.the
1 ahaB ns empty say pew N any manner n n to become gub�ect to the WATER SYSTEMr FA,IING
WmApplica Comperwtbn tawsd Gll(°mh.Date PAID
C' Z NOUCnt NEWRESIDENTALPI.MB. SQFr. Dale Recei t#
.Z O Nmld IO AEPLICAtothe o m'Comhh CertHlp of Exemptbn,yw
shouldbemnr Orth to the ply wit C i,h pro atbnpnovhbnofthe Labor TOTAL
~ > deemed
res cet forthwith comply Mtn such provbbtu or this permit shall he
`� > seemed rew4ad. BUILDING FEE
a G CONSTRUCTION LENDING AGENCY SEISMIC FEE
I hereb efirmtkt them ba mraeuction lendln a eruy fortk perform-
i.7 = armofthe work for which this permit is homed 6ec 3�,Civ.C.) ELECTRIC FEE' I
V O fender.Name - PLUMBING FEE
ly F lenaer.Aga.,, QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
O W 1certify the l have read this applications rd nate that the above...rmrtlm
hmnect.Iagree to comply with al city and county ordWnms and gate laws PERMIT iSSUANCE FEE$PAID:
} C relating to bulldog covhuslon,and hereby authorlu represnutNn ofthh
city to enter upon the above-mentioned property for inspection purposes. ALTERORADDTOMBCFL DRIB Recel t
V (We)agrn to one,Itdemdy and keep harMes_the City of Gapertiro
agaWtlhbiB<b,ydgmenb,cons and esperaes whkh mayb nywayacaue AIR HANDLING UNIT(TO 10,000 CFM)
aga wt said City In consequenoe of the grant Ing d this permit. SUBTOTAL:
i
AIR HANDLING UNIT(OVER 10,"CFM) CONSTRUCTION TAX
Signature of Applicunt/Contractor Date E01AUST HOOD(W/DUCT) CONSTRU(ZTIO T
HAZARDOUS MATERIALS DISCLOSURE -
Willthe applkantmfuture bulldingoaupant store or handle ha:ardos IfEATNG UMTOO 100,000 BTU) Date RL`C I
meertl as defined by the Cupertim MuNdpal Cade,Chapter 9.1Z red the '
I health ard SafcyC Ica 2&532(.)7 HEATING UNIT(OVER 10,000 B'T'U) •I•
I ❑ Yes °
Will
rout".nd uo .au nniab e.&findby thq.e Bay A or devices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE
� hkheMtluvrdws conumWnundefired by the&y Area Nr n p
Quality Ma rugementl [fl tl BOR.FR-NMP PEIPOR 100,000 BTU) p� {y I D
4 Yn a�T/dl No
have read thele s materials requirements underChapier 6.95 of BOILEROOMP(OVpt 100,000 BTU)
rice GOfomhlla"h&Safety Code,Sesbro25505,2&533nd2&534. I ve `JUN 281994
undunand tluti(<he bull ngdoesnercumen aa tenh ant,that it my NEW RESIDENTIAL MECIL SQYT
respomib0ityi rosily osu of a menbwhkhmustberrct
of. if f pan
-ta CITY Ut II;Uf'LKIIN"
Date — ISSUED BY:
�I
OFFICE COPY